Spotlight on Research

Prehospital acute pain management research in adults often focuses on analgesic administration: ‘what proportion of patients received an analgesic?’, ‘did a meaningful pain score reduction occur?’, ‘were there any adverse events?’ Pain is best understood using Engel's biopsychosocial model of health as the underpinning framework, where analgesic administration addresses the biological and, to some extent, the psychological remit of pain. The psychosocial component of pain is often underrepresented in clinical research. Our latest systematic review and meta-synthesis (Whitley et al, 2023) aimed to address this gap in the literature.

We synthesised the qualitative experiences of patients, their family members, and ambulance staff involved in the prehospital management of acute pain in adults, and generated recommendations to improve quality of care. Twenty-five articles were included in the review, representing over 464 patients, family members, and ambulance staff from eight countries.

It was found that prehospital acute pain management in adults requires a holistic approach that promotes patient empowerment, develops trust and addresses patient needs and expectations. While these are broad, high-level recommendations, as individual clinicians, we can adapt these to our local context. For example, to promote patient empowerment, we could create conditions of participation (perhaps by suggesting a range of immobilisation or patient positioning techniques and supporting the patient to find their optimum comfort level), and adapt to the patient's needs (by adjusting the environment [light, noise and temperature level], analgesic regime [increase or decrease dosing] or level of psychosocial support [reassurance, hand holding, relative proximity].